Introduction:

Lower extremity lymphedema is a major source of morbidity in up to 70% of penile cancer patients who undergo inguinal lymphadenectomy (ILND). Lymphedema is thought to be incurable, though lymphovenous bypass (LVB) has emerged as a surgical treatment largely in breast cancer patients. To our knowledge this study is the first to apply LVB to penile cancer patients status post ILND.　　

Methods:

We performed microsurgical LVB in three patients who underwent ILND for advanced penile cancer. Figure one demonstrates how LVB is performed between the lymphatic vessel and neighboring venule. LVB was performed by a trained microsurgeon: two patients were treated as outpatients for lymphedema, and one patient underwent prophylactic LVB simultaneously with initial ILND.

Results:

Figure two demonstrates intraoperative LVB using 11-0 prolene with visible flow of radiotracer indocyanine green on infared imaging. We saw significant improvement in clinical lymphedema for two of three patients. There were no adverse events from LVB.

Conclusion:

This early proof of concept study shows that this outpatient procedure may be an effective treatment for lower extremity lymphedema following ILND.

Funding: N/A